未经治疗的HBeAg阳性慢性HBV感染的自然病史，HBV DNA持续升高

StephenW

Clin Transl Gastroenterol. 2020 Mar;11(3):e00140. doi: 10.14309/ctg.0000000000000140.
Natural History of Untreated HBeAg-Positive Chronic HBV Infection With Persistently Elevated HBV DNA but Normal Alanine Aminotransferase.
Lee HW1,2, Kim EH3, Lee J3, Kim SU1,2, Park JY1,2, Kim DY1,2, Ahn SH1,2, Han KH1,2, Kim BK1,2.
Author information

1
    Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
2
    Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea.
3
    Biostatics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea.

Abstract
OBJECTIVES:

Nucleos(t)ide analogues (NUCs) are not routinely recommended for patients with hepatitis B e antigen-positive chronic hepatitis B virus (HBV) infection who have persistently elevated serum HBV DNA level (>20,000 IU/mL) but normal alanine aminotransferase (<40 IU/L) level. Here, we evaluated the cumulative risks of hepatocellular carcinoma (HCC) in such patients (the untreated persistently elevated serum HBV DNA [pEDNA] group) compared with inactive carriers (the IC group).
METHODS:

Patients with untreated pEDNA (n = 126) and IC (n = 621) were enrolled between 2006 and 2012. Patients with cirrhosis or HCC at enrollment or a history of NUC treatment were excluded.
RESULTS:

The cumulative HCC risks at 5 and 9 years in the untreated pEDNA group were 1.1% and 1.9%, which were comparable with those of the IC group (P = 0.549). Inverse probability of treatment weighting and propensity score matching also showed similar HCC risks. In the untreated pEDNA group, there were no cases of HCC in the subgroup with serum HBV DNA level >1,000,000 IU/mL (immune-tolerant phase), which was significantly (P = 0.002) different compared with those with an intermediate serum HBV DNA level (20,000-1,000,000 IU/mL).
DISCUSSION:

The cumulative HCC risk in the untreated pEDNA group was minimal and comparable with that of the IC group. Further studies are required to determine whether early NUC treatment, indeed, reduces the HCC risk in patients with an intermediate serum HBV DNA level.

PMID:
    32352711
PMCID:
    PMC7145045
DOI:
    10.14309/ctg.0000000000000140

StephenW

临床翻译胃肠病。 2020年3月； 11（3）：e00140。 Doi：10.14309 / ctg.0000000000000140。
未经治疗的HBeAg阳性慢性HBV感染的自然病史，HBV DNA持续升高，但丙氨酸转氨酶正常。
Lee HW1,2，Kim EH3，Lee J3，Kim SU1,2，Park JY1,2，Kim DY1,2，Ahn SH1,2，Han KH1,2，Kim BK1,2。
作者信息

1个
延世大学医学院内科，韩国首尔。
2
大韩民国首尔遣散医院延世肝脏中心。
3
延世大学医学院生物医学系统信息学系生物静力学合作单位，韩国首尔。

抽象
目标：

乙型肝炎e抗原阳性的慢性乙型肝炎病毒（HBV）感染的患者血清HBV DNA水平持续升高（> 20,000 IU / mL）但丙氨酸转氨酶正常（ <40 IU / L）水平。在这里，我们评估了这类患者（未经治疗的血清HBV DNA持续升高[pEDNA]组）与无活性携带者（IC组）相比的肝癌（HCC）累积风险。
方法：

在2006年至2012年之间纳入了未经治疗的pEDNA（n = 126）和IC（n = 621）的患者。入组时有肝硬化或HCC或有NUC治疗史的患者被排除在外。
结果：

未经治疗的pEDNA组在5年和9年时的累积HCC风险分别为1.1％和1.9％，与IC组相当（P = 0.549）。治疗权重和倾向评分匹配的逆概率也显示出类似的HCC风险。在未经治疗的pEDNA组中，亚组中没有血清HBV DNA水平> 1,000,000 IU / mL（免疫耐受期）的HCC病例，与中等血清HBV DNA相比有显着差异（P = 0.002）浓度（20,000-1,000,000 IU / mL）。
讨论：

未经治疗的pEDNA组的累积HCC风险极小，与IC组的HCC风险相当。需要进一步的研究以确定早期NUC治疗是否确实降低了中度血清HBV DNA水平患者的HCC风险。

PMID：
32352711
PMCID：
PMC7145045
DOI：
10.14309 / ctg.0000000000000140

StephenW

https://journals.lww.com/ctg/Ful ... eAg_Positive.7.aspx